Modifier 25 Information Request Question Title * 1. First Name OK Question Title * 2. Last Name OK Question Title * 3. Provider Type OK Question Title * 4. In what state or U.S. territory do you practice? Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (DC) Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming OK Question Title * 5. Association OK Question Title * 6. Role Physician Officer Staff Other OK Question Title * 7. Title (if any) OK Question Title * 8. For future updates on modifier 25 efforts please provide email OK Please email David Brewster, Assistant Director of Practice Advocacy, with the American Academy of Dermatology Association at DBrewster@aad.org with any questions. OK DONE